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Dental Anesthesia > Test 3- The Drugs > Flashcards

Test 3- The Drugs Flashcards

1
Q

what are the generic names of amides

A 
articaine
bupivicaine
mepivicaine
lidocaine
prilocaine
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2
Q

what are the trade names for articaine

A

articadent orabloc, septocaine, zorcaine

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3
Q

what are the trade names for bupivicaine

A

marcaine, vivacaine

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4
Q

what are the trade names for lidocaine

A

lingospan, octocaine, xylocaine

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5
Q

what are the trade names for mepivicaine

A

carbocaine, isocaine, polocaine, scandanest

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6
Q

what is the trade name for prilocaine

A

citanest

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7
Q

what letter will inciate that it is an amide

A

an I before caine

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8
Q

what is novacane

A

ester

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9
Q

what is the trade name for novacane

A

procane

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10
Q

what are examples of relative contraindications

A

-atypical plasma cholinesterase
-methemoglobinemia
-significant liver dysfunction, liver dysfunction, cardiovascular disease
-clinical hyperthyroidism
-

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11
Q

what should you avoid with someone who is ASA III-IV

A

racemic epi gingival retraction cord

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12
Q

what should you do with someone what has a significant liver or renal dysfunction or cardiovascular disease

A

use less LA

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13
Q

what should you not do with someone who has methemoglobinemia

A

do not use prilocaine

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14
Q

what should you not use with someone who has atypical plasma cholinesterase

A

esters

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15
Q

what should you be careful with with someone who has clinical hyperthyroidism

A

vasoconstrictor amount

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16
Q

what are the absolute contraindications

A
  • a true documented allergy

- bisulfite allergy

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17
Q

what should you do if your pr has a bisulfite allergy

A

use local without a vasoconstrictor

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18
Q

what are people allergic to who have a bisulfite allergy

A

the preservative

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19
Q

what is duration of LA influenced by

A
  • individual response (bell curve)
  • accuracy of admin
  • status of oral tissue
  • anatomical technique
  • faulty technique
  • type of injection
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20
Q

what are the two greatest things that influence the duration of LA

A

faulty technique, anatomical variation

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21
Q

what are normal responders

A

the majority of people respond of a predictable manner

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22
Q

what are hyper responders like

A

they get very numb and stay numb for long periods of time

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23
Q

what are hypo responders like

A

the barely feel numb and lose the anesthesia faster

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24
Q

what would cause a parasthesia

A

a 4% solution over a 3 or 2%

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25
Q

why would you use a 1:50,000 epi solution

A

for good hemostasis

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26
Q

What type of injection lasts longer

A

nerve block

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27
Q

what type of injection is shorter in duration

A

infiltration

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28
Q

what is the other name for an infiltration

A

supraperiosteal

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29
Q

what does less volume of an anesthetic do

A

decreases duration

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30
Q

does more volume of anesthetic increase duration

A

not necessarily

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31
Q

what should you use for epi sensitive patients

A

prilocaine

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32
Q

what can prilocaine do to the blood

A

it reduces its blood oxygen carrying capacity

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33
Q

what are the unsubstantiated claims about articaine

A

-parasthesia
increased quality
provides pulpal and ling anesthesia via inflitration in adult mandible

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34
Q

where should you never use articaine

A

in a IA

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35
Q

what drug lessesns the patients needs for post op opiod analgesics because of its long duration

A

bupivicaine

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36
Q

what does the percentage on the carpule indicate

A

the amount of LA mg per ml of anesthetic

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37
Q

how much LA in a 2 % solution

A

20 mg/ml

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38
Q

how much LA in one carpule with 2% solution

A

36 mg of drug

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39
Q

if there is 36 mg of drug in on 2% solution carpule how much in 2

A

72 mg of drug

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40
Q

who is tissue trauma common in with LA

A

very young and very old

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41
Q

who are the medically compromised

A

changes in liver function
plasma protein building
blood volume
those that have biotransormation and LA distribution problems

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42
Q

The MRD should be decreased in which individuals

A

debilitated
elderly
medically compromised
kids

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43
Q

what is the concentration like in topical anesth

A

it is greater than injection LA

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44
Q

what does the high concentration of topical facilitate

A

diffusion through mucous membrane

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45
Q

how far down does topical penetrate

A

2-3 mm

46
Q

what is the mode of action of topical LA

A

-insoluble in water

slowly absorbed into cardiovascular system which decreases chance of toxicity

47
Q

what is the site of action of topical LA

A

mucous membrane

48
Q

is spray topical recommended

A

no

49
Q

what kind of anesthetic is an EMLA

A

an amid

50
Q

what is another name for EMLA

A

eutetic anesthetic

51
Q

what is an example of an EMLA

A

Oraquix

52
Q

how do emla/eutetic anesthetics work

A

they soak through intact epidermal tissues

53
Q

what are EMLAs

A

a highly concentrated anesthetic

54
Q

does EMLA provide pulpal anesthesia

A

yes a little

55
Q

what factors are important when selecting LA

A
  • length of time
  • potential for pain after
  • shorter acting for children or mentally disabled
  • hemostasis
  • contraindications
56
Q

what should epi sensitive patients be limited to

A

2 cartridges of 1:100,000 epi per appt (MRD is .04mg)

57
Q

who are the epi sensitive pts

A

cardiovascularly compromised and hyperthyroid patients

58
Q

what anesthetic is preferred in most non surgical dental procedures

A

2% lido with 1:100,000 epi

59
Q

what does 2% lido with 1:100,000 provide

A

as much duration and depth as 1:50,000 with a lower concentration of epi

60
Q

what is mepivicain plain always

A

3%

61
Q

What are local complications of LA

A 
hematoma, trismus
needle breakage
parasthesia
facial nerve paralysis
soft tissue injury
pain on inj
burning on inj
infection
edema
sloughing of tissues
62
Q

where does a PSA hematoma usually manifest

A

lower aspect of the mandible

63
Q

where is the weakest place on a needle

A

the hub

64
Q

why do needles usually break

A

bending the needle

65
Q

what gauge of needle is best

A

27 gauge

66
Q

what else can cause a broken needle

A

sudden pt movement

67
Q

what is paresthesiA

A

numbness that lasts longer than it should

68
Q

what does paresthesia feel like

A

numb or frozen, swelling, tingling, itching

69
Q

what are the oral dysfunctions of parasthesia

A

tongue biting, drooling, loss of taste, speech impediment

70
Q

how long does parasthesia last

A

can last for days or months usually 2 mo

71
Q

what is the main cause of parasthesia

A

trauma to any nerve

72
Q

what are other causes of parasthesia

A

-contaminated LA solution
-trauma to nerve sheath
insertion of needle into foramen
type of LA usedd

73
Q

what are symptoms of parasthesia

A

irritation, resulting in edema and increased pressure by nerve leading to parasthesia

74
Q

what is the most common cause of parasthesia

A

contaminants

75
Q

what do contaminants to LA produce

A

long term trauma to the nerve

76
Q

what is parasthesia

A

loss of sensation

77
Q

what is hyperesthesia

A

increased sensitivity to noxious stimuli

78
Q

what is dysesthesia

A

bad anesthesia, painful sensation to usually non noxious stimuli ex zinging instead of numbness

79
Q

what do para, hyper and dysesthesia usually resolve

A

8 weeks

80
Q

what is muscle droop

A

ptosis

81
Q

what is the cause of facial nerve paralysis

A

deposition of LA in deep lobe of parotid gland which contains terminal branches of the facial nerve

82
Q

where is the parotid located

A

posterior border of mandibular ramus

83
Q

how long does is take the parotid to become un numb

A

at the same rate the anesthetic should

84
Q

what will happen to the facial muscles in facial nerve paralysis

A

loss of motor function of facial nerves (not masticatory), unilateral paralysis, unable to close one eye

85
Q

what is trismus

A

prolonged spasm of jaw muslces, normal opening of jaw is restricted (lock Jaw)

86
Q

what is the cause of trismus

A 
too many needle pokes
trauma to muscles or blood vessls in infratemporal fossa
hemorrhage
low grade infection after injection
barbed needle
87
Q

what is a hematoma

A

effusion of blood into extravascular spaces, when you nick an artery or vein

88
Q

why is a hematoma a problem

A

bruise, trismus and pain, inconvenience and embarrassment

89
Q

why can a patient experience pain on injection

A

careless technique
dull needle
rapid deposition of solution
barbed needle

90
Q

why may a patient feel burning on injection

A

ph of solution
rapid injection
contamination of cartridge
solution too hot

91
Q

what is there a possible higher likelihood of with burning on injection

A

trauma

92
Q

how do you prevent burning on injection

A

slow deposition

93
Q

what is the rate you shouldnt exceed when injecting

A

1.8 ml/min

94
Q

where does the potential toxicity of a drug rest

A

in the hands of the user

95
Q

do drugs have a single action and are devoid of toxicity

A

no

96
Q

what are predesposing factors for systemic complication

A

age, weight, other meds, sex, presence of disease, genetics, mental attitude and environment

97
Q

what should be decreased if they have predisposing factors

A

MRD

98
Q

what are causes of overdose

A
  • slow biotransformation
  • unbiotransformed drug too slowly eliminated through kidneys
  • too large of dose admin
  • absorbtion from inj site unusually rapid
  • inadvertent intravascular admin
99
Q

what should you do to avoid overdose

A

aspirate

100
Q

what can someone sue for

A

standard of care

101
Q

what is the standard of care

A

minimal level of acceptable performance

102
Q

how is the standard of care measured

A

locally and nationally

103
Q

what is the best form of defense in dental office

A

documentation

104
Q

what is important to document in documentation

A

lack of compliance or now shows

105
Q

how long do you have to sue someone in utah

A

from the time a problem is discovered up to 2 years

106
Q

how long do dental offices maintain records

A

7 years

107
Q

if a pt refuses xrays and you document they didnt want them does it exclude you from legal matters

A

no

108
Q

malpractice only covers what

A

practicing within scope of practice

109
Q

if your licence is on probation can you still work

A

yes

110
Q

if you commit a crime can DOPL take your licence

A

yes

111
Q

what does buffered LA do

A

changes pka so it works faster

112
Q

what does phentolamine mesylate do

A

kicks cations off of gates so na pumps work to get un numb faster

Dental Anesthesia (8 decks)

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